Category Archives: Vegetarian Diet

I ask because I’m probably going to put together some low-carb Indian food recipes later this year. Why bother to compose meat-heavy recipes if Indians are predominantly vegetarian?

For the rest of this article, when I mention Indians, I’m talking about Indians in India. Not Indians in the U.S. or U.K. or elsewhere. Here’s what I’ve learned so far.

First off, note that vegetarianism isn’t a monolithic way of eating. Here are common subgroups:

Vegan: eat no meat, poultry, fish, eggs, and dairy products whatsoever, probably not even honey (look up how bees make honey)

Lacto-vegetarian: eat no meat, poultry, fish, or eggs, but dairy products are okay

Lacto-ovo vegetarian: eat no meat, poultry, or fish, but eggs and dairy products are fine

Pesco-vegetarian: eat no meat or poultry, but fish are okay (what about eggs and dairy?)

Semi-vegetarian: eat meat, poultry or fish at least once a month but less than once a week

Surveys of Indians indicate that only 30% of the population, let’s call it one out of three, label themselves as vegetarian. The most common vegetarian strain is semi-vegetarianism. Admittedly, some sources say lacto-vegetarians are predominant. It’s a close call. Pesco-vegetarians are the smallest vegetarian group.

By comparison, only 2.4% of U.S. adults are vegetarian.

Even non-vegetarian Indians don’t eat much meat—once a week is not uncommon. For instance, in 2015 average annual meat consumption per capita in Americans was 210 lb. The figure for Indians was 6.4 lb! Non-vegetarians in the U.S. eat five times as much meat as non-vegetarians in India.

Compared to non-vegetarians in In India, vegetarians are more likely to be women, over age 55, college-educated, non-smokers, and more sedentary.

Indian vegetarians don’t eat a lot of eggs but do eat a fair amount of milk/diary products.

Vegetarianism is highly variable depending on geography and the make-up of the population. For example, the state of Gujarat has many vegetarians. Also, wherever you find many Brahmins and Jains, there are beaucoup vegetarians.

There are many Hindus in India. A key principle of Hinduism is nonviolence. Killing an animal and eating it is violent. Hence, vegetarianism.

Vegetables are staples of Indian cuisine, and a variety of spices keep them interesting. Rice and breads are also prominent. Legumes (aka pulses) contribute 5% of calories to Indian diets.

South Asia is typically comprised of India, Pakistan Afghanistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives. The most populous of these is India, with 1, 326, 000,000, followed by Pakistan (193,000,000) and Bangladesh (163,000,000). India is also the largest geographically, and in the center of the region. The article at hand was based on surveys, called food propensity questionnaires, of folks in Chennai and New Delhi (both in India) and Karachi (Pakistan).

The researchers were interested in the “South Asian Paradox”: “The prevalence of cardiometabolic diseases such as diabetes and coronary heart disease is increasing disproportionately in South Asian compared with other regions of the world despite high levels of vegetarianism.” Why is this, when the vegetarian diet is supposed to be so healthy? (Prevalence of diabetes in India rose from 6.7% in 2006 to 9.3% in 2014.) The authors wonder if the Indian vegetarian diet is less healthy than U.S. and European vegetarian diets. They write that “The health benefits of vegetarian diets observed n the present study may stem from higher intakes of vegetables and legumes among vegetarians compared with non-vegetarians.” I don’t find any firm conclusions that would resolve the South Asian Paradox. They say U.S. vegetarians have more consistently “healthier” food group intakes than South Asian vegetarians: lower consumption of dairy, desserts, and fried foods. They speculate that the healthfulness of the South Asian vegetarian diet might be improved by limiting fried foods and increasing nutrient-dense fruits, nuts, seeds, and whole grains. Higher legume consumption, particularly by non-vegetarians, may also the healthful.

They note that although diseases like diabetes and cardiovascular disease have increased markedly in India over the last 35 years, annual per capita consumption of poultry, meat and fish has only increased by 1 kg.

I wouldn’t be surprised if the South Asian Paradox is largely unrelated to specific foods.

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New Zealand researchers found significant long-term weight loss and improved cholesterol levels over six and 12 months with a low-fat vegetarian diet. Surprisingly, this was accomplished without restriction on calories and without an exercise component. Weight loss measured at six months was 27 lb (12.1 kg) and they only gained a little back over the subsequent six months.

The authors think the successful weight loss was from “… the reduction in the energy density of the food consumed (lower fat, higher water and fibre). Multiple intervention participants stated ‘not being hungry’ was important in enabling adherence.”

I scanned the research report pretty quickly and don’t see that they referred to the diet as vegetarian. Here’s their test diet description:

We chose a low-fat iteration of the plant-based diet [7–15% if calories as fat] as this has been shown with previous research to achieve optimal outcomes, especially for heart disease and weight loss. This dietary approach included whole grains, legumes, vegetables and fruits. Participants were advised to eat until satiation. We placed no restriction on total energy intake. Participants were asked to not count calories. We provided a ‘traffic-light’ diet chart to participants outlining which foods to consume, limit or avoid. We encouraged starches such as potatoes, sweet potato, bread, cereals and pasta to satisfy the appetite. Participants were asked to avoid refined oils (e.g. olive or coconut oil) and animal products (meat, fish, eggs and dairy products). We discouraged high-fat plant foods such as nuts and avocados, and highly processed foods. We encouraged participants to minimise sugar, salt and caffeinated beverages.

Perfect diet compliance would make this a vegan diet. I didn’t catch it in the text of the article, but I’m guessing protein calories were 10–15% of the total, and carbohydrates were around 75%.

The researchers called their investigation the BROAD study. All study subjects were overweight or obese adults. A control group ate their regular foods. The intervention group eating the whole food plant-based diet numbered 33, including 7 with type 2 diabetes. All studies like this have people that drop out. I.e., they quit or otherwise get lost to follow-up. Of the intervention group, 75% lasted for six months, 70% stuck with it for the entire 12 months.

There weren’t enough diabetics in the study to make statistically significant conclusions, but the authors write, “Hemoglobin A1c reductions favoured the intervention and all intervention patients with a diabetes diagnosis improved while adherent, and two resolved their condition by HbA1c.”

I’d love to see these researchers repeat this study with 50–100 overweight or obese folks with T2 diabetes. Clearly, it’s a radically different diet than what I recommend for my patients with diabetes.

Steve Parker, M.D.

PS: For science nerds, here’s the study abstract:

Background/Objective: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).

Subjects: Ages 35–70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.

Conclusions: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.

It works for David Mendosa, who’s been doing it for three years. He shares some ideas on how to do it at the link below. From the intro:

About nine years ago, I started to eat only food low in carbohydrates that don’t have a high glycemic index. I knew that this was the only proven way to bring my blood glucose level down where I wanted it to be without using drugs or supplements. My most recent A1C test showed that my level is 5.1 percent, well within the range considered normal.

While continuing to eat this way, about three years ago I added the further restriction of eating no meat, fish, or seafood. This was a substantial shift in what I was eating, and I made it mainly because I don’t want to be intentionally responsible for the death of animals or other sentient beings. Only later did I begin to realize its health benefits.

David seems to adhere to the lacto-ovo strain of vegetarianism, rather than vegan or pesco-vegetarian. In other words, he’ll eat eggs and milk products but not fish. I suspect he eats under 40 grams/day of digestible carbohydrate.

Vegetarian diets vary considerably depending on the degree of dietary restrictions. According to the strictest definition, a vegetarian diet consists primarily of cereals, fruits, vegetables, legumes, and nuts; animal foods, including milk, dairy products, and eggs generally are excluded. Several less restrictive vegetarian diets may include eggs and dairy products. Some vegetarian diets may be grouped as follows:

●Macrobiotic — Vegetables, fruits, legumes, and seaweeds are included in the diet, while whole grains, especially brown rice, are also emphasized. Locally-grown fruits are recommended. Animal foods limited to white meat or white-meat fish may be included in the diet once or twice a week.
●Semi-vegetarian — Meat occasionally is included in the diet. Some people who follow such a diet may not eat red meat but may eat fish and perhaps chicken.
●Lacto-ovovegetarian — Eggs, milk, and milk products (lacto = dairy; ovo = eggs) are included, but no meat is consumed.
●Lactovegetarian — Milk and milk products are included in the diet, but no eggs or meat are consumed.
●Vegan — All animal products, including eggs, milk, and milk products, are excluded from the diet. Some vegans do not use honey and may refrain from using animal products such as leather or wool. They also may avoid foods that are processed or not organically grown.

A 2012 poll estimated that 7% of U.S. adults eat at least one meal a week that does not include meat, fish or poultry, 4% do not eat meat, fish, or poultry, and 1–2% do not eat meat, fish, poultry, dairy products, or eggs. Roughly 5% of individuals in the UK, Germany, and Australia describe themselves as vegetarian.

Are Vegetarian Diets Safe?

Vegetarians need to be careful to get enough high-quality protein, iron, vitamin B12, vitamin D, and perhaps calcium. B12 comes only from animal products, as far as I know. You can make vitamin D by exposing your skin to sufficient sunlight. Some vegetarians will need to consult a dietitian to ensure adequate nutrition. (BTW, all my comments about vegetarian diets apply to adults only—I don’t treat children, so I’m not up-to-date on their nutritional needs.)

“The assayed Ma-Pi 2 diet is lower in energy than the traditional one recommended for diabetic patients, but safe, with adequate satiating effect due to the high fiber content, adequate in protein (12% of the total energy), with an acceptable amino acid score, low in fat (15% of the total energy), and high in complex carbohydrates (73%). The diet has a high antioxidant capacity and a high content of bioactive compounds with recognized functional properties (Table 2). Foods were elaborated by culinary macrobiotic specialists from UPM, Italy, and offered at the hospital during breakfast, lunch, dinner and snacks. Unfortunately, the variety of vegetables was restricted because of limited availability.”

I wonder if that would be deficient in vitamin B12.

It looks like it would be worth a try for a type 2 diabetic under medical supervision (some risk of hypoglycemia). I’d like to try a few meals with those ingredients, some of which I’ve never heard of, prepared by someone who knows what they’re doing. Unless I missed it in the link, it might be hard for the average person to replicate that study diet. If I understood correctly, the study participants stayed in a hospital for three weeks and meals were prepared for them.

I don’t have time to hit the other links right now.

-Steve

My Current Stance on Vegetarian Diets For Diabetes

I say “current stance” because I’ll change my mind based on scientific evidence as it becomes available.

I’m not convinced that any of the vegetarian diets is clearly superior to the other available “diabetic diets” in terms of quality of life, longevity, and avoidance of diabetes complications.

We have some evidence that some vegetarian diets may help control diabetic blood sugars and help reduce the need for diabetes medications, at least short-term.

If my diabetic patients want to try a vegetarian diet, I have no objections as long as these criteria are met:

PS: Did you catch that the Ma-Pi 2 diet is “lower in energy than the traditional one recommended for diabetic patients…”? That means a reduced-calorie diet. Drop calories enough on most any diet, and you’ll likely see lower serum glucose levels, reduced triglycerides (and perhaps other lipid improvements), and loss of excess weight.

A vegan diet was superior to a low-fat diet over the course of three weeks, in terms of blood sugar, hemoglobin A1c, total cholesterol and LDL cholesterol. The vegans were also able to use fewer drugs.

The vegans in the study at hand ate 15–20 more grams/day of fiber. High fiber intake is linked to better blood sugar control.

From the study abstract:

After correcting for age, gender, BMI at baseline, and physical activity, there was a significantly greater reduction in the primary outcomes fasting blood glucose and after-meal glucose in those patients receiving the Ma-Pi 2 diet compared with those receiving the control diet [low-fat]. Statistically significantly greater reductions in the secondary outcomes, HbA1c, insulin resistance, total cholesterol, LDL cholesterol and LDL/HDL ratio, BMI, body weight, waist and hip circumference were also found in the Ma-Pi 2 diet group compared with the control diet group. The latter group had a significantly greater reduction of triglycerides compared with the Ma-Pi 2 diet group.

I just finished reading The Low Carb Dietitian’s Guide to Health and Beauty, written by Franziska Spritzler, RD, CDE, and published in January 2015. CDE, but the way, means Certified Diabetes Educator. Per Amazon’s rating system, I give it five stars (I love it). It’s not written specifically for women with diabetes, but the included recipes are quite consistent with a healthy diabetic diet. Since the author provides the carbohydrate grams with her recipes, you can use them with my Low-Carb Mediterranean Diet and Ketogenic Mediterranean Diet.

* * *

This valuable addition to the low-carb literature is unique: No other book covers the beauty and health aspects of low-carb eating specifically in women.

I’m a strong proponent of carbohydrate-restricted eating for weight management and cure or control of certain medical conditions. The great advantages of low-carbing for weight loss are 1) suppression of hunger, and 2) proven greater efficacy compared to other types of dieting. Nevertheless, I wasn’t aware that this way of eating also had potential benefits in terms of beauty maintenance or improvement. The author persuasively makes that case in this ground-breaking book.

Just because she has RD (registered dietitian) behind her name doesn’t mean you just have to take her word for it. Franziska gives us references to the scientific literature if you want to check it out yourself.

The author focuses on health and beauty; the weight loss happens naturally with low-carb eating. That’s a helpful “side effect” since 2/3 of women in the U.S. are overweight or obese.

She covers all the basics of low-carb eating, including the rationale, potential side effects and how to prevent or deal with them, the science of “good fats,” the importance of plant-derived foods and fiber, info on artificial sweeteners, and management of weight-loss stalls.

Then Franziska does something else unique and very helpful. She offers three different eating plans along with a simple test to help determine which is the best for you. The options are 1) low-carbohydrate diet, 2) high-fiber, moderate saturated fat, low-carb diet, and 3) intermittent fasting low-carb diet with weekly treat meal. You can dig right in with a week’s worth of easy meals made from readily available ingredients.

It was interesting for me to learn that the author ate vegan-style and then pescetarian for awhile. In 2011 she was eating the usual doctor-recommended “healthy” low-fat high-fiber diet when life insurance blood work indicated she had prediabetes. So she cut her daily dietary carbs from 150 grams to 50 or less, with subsequent return of the labs to normal ranges.

I only had a few quibbles with the book. For instance, there’s no index, but that’s mitigated by a very detailed table of contents. The font size is on the small side for my 60-year-old eyes. If either of those issues bother you, get the ebook version. “Net carbs” are mentioned briefly before they are defined, which might confuse folks new to low-carbing.

A particular feature that appealed to me is the vegetarian meal options. Low-carb eating is often criticized as being meat-centric. Franziska shows it doesn’t have to be.

I also appreciate that she provides the net carb grams and calorie counts for her meal plans and recipes. All diabetics and many prediabetics need to know the carb grams. Calorie counts come in handy when analyzing the cause of a weight loss stall. Yes, calories still count in weight management.

I don’t think it’s giving too much away to say that the author’s top low-carb beauty foods are avocados, berries, cinnamon, cocoa/dark chocolate, fatty fish, flaxseed, full-fat dairy, green tea, nuts, olives/olive oil, and non-starchy vegetables. I was skeptical at the start of the beauty foods chapter, but Franziska’s scientific references support her recommendations. I’m already eating most of these foods. Now I’m going to try green tea and ground flaxseed (e.g., her flaxseed bread recipe).

The author will also get you going on exercise. I heartily agree with her that exercise is truly a fountain of youth.

Menopausal? The author has your special challenges covered.

If you’re curious about the paleo diet, note that only about a quarter of these recipes are pure paleo. Dairy products disqualify many of them.

Here are a just a few tidbits I picked up, to help me remember them:

a blood test called fructosamine reflects blood sugar levels over the previous three weeks

you’ll have less wrinkles if you can reduce the advanced glycation end-products (AGEs) in your skin

Japanese women on the highest-fat diets have less wrinkling and better skin elasticity

Links

“Do not be deceived: God cannot be mocked. A man reaps what he sows. Whoever sows to please their flesh, from the flesh will reap destruction; whoever sows to please the Spirit, from the Spirit will reap eternal life.”